Choose to Be Informed About ChronicPreparing Pelvic Painfor SurgeryConditions | | 3 1 Choose to Be Informed About Chronic Pelvic Pain Conditions. Pelvic Pain Conditions 2 Women’s Services at Every Age and Stage of Life 5 Screenings You Need 6 – 7 Your Medical History 8 – 10 Family History 11 – 12 My Physicians 13 Choose to Be Informed About ChronicPreparing Pelvic Painfor SurgeryConditions | | 3 2 Gynecological issues involving the pelvic area affect many women during their lifetime. Chronic pelvic pain is pain located between the stomach and hips that lasts for six months or longer. For women, there can be many different causes of pelvic pain. This guide explains the most common types of female pelvic conditions and what can be done to treat them. Abnormal Uterine Bleeding Painful Periods Abnormal uterine bleeding is defined as bleeding that Painful menstrual periods, also called dysmenorrhea, occurs between periods, or is heavier or lasts longer are the leading cause of lost time from school and than normal. Menstrual cycles that are longer than 35 work among women in their teens and 20s. Painful days or shorter than 21 days are considered abnormal. periods may include pain in the pelvis, abdomen, Bleeding that occurs after intercourse or any time after back and legs; abdominal cramps; headache; and menopause is also abnormal. fatigue. There are many possible causes of abnormal uterine There are two types of dysmenorrhea. Primary bleeding, including fibroids, polyps, infection dysmenorrhea is caused by high levels of or cancer of the uterus or cervix, polycystic prostaglandins — hormone-like substances — in the ovary syndrome (an endocrine system disorder), uterus. Secondary dysmenorrhea can be caused by endometriosis or adenomyosis. Pregnancy, endometriosis, ovarian cysts, pelvic inflammatory miscarriage and ectopic pregnancy can also cause disease, uterine fibroids, inflammatory bowel disease, abnormal uterine bleeding. tumors or an intrauterine device (IUD). Abnormal uterine bleeding can occur at any age. Diagnostic options your doctor may consider include: However, it more commonly occurs as a woman • Pelvic ultrasound exam – A noninvasive exam nears menopause (around age 50), as it is normal to that produces images of the pelvic organs from skip periods or for bleeding to get lighter or heavier at sound waves generated from a probe placed on this time. your body. Treatment of abnormal uterine bleeding depends • Hysteroscopy – A procedure that utilizes a thin, on many factors, including the cause, your age and lighted tube called a hysteroscope to examine the whether you want to have children. Many women inside of the uterus. can be treated with medication or hormone therapy, while others may need surgery. Doctors can perform • Hysterosalpingogram – An X-ray procedure endometrial ablation to treat many causes of heavy performed to assess whether the fallopian tubes bleeding. This procedure, which destroys a thin are open or blocked. layer of the uterus lining to stop menstrual bleeding, • Pelvic laparoscopy – A procedure that uses an can be performed through radiofrequency, freezing, instrument called a laparoscope to view the microwave energy, heated fluid or electrosurgery. reproductive organs. Hysterectomy, removal of the uterus, may To relieve the pain of primary be an option when other treatments dysmenorrhea, your doctor may have failed or are not feasible. recommend medications and Minimally invasive hysterectomy certain lifestyle changes. procedures typically result in The treatment of secondary less pain and scarring, and dysmenorrhea varies depending a faster recovery than open on the underlying condition. hysterectomy surgery. Choose to Be Informed About ChronicPreparing Pelvic Painfor SurgeryConditions | | 3 3 Endometriosis and transmitted infections. Pelvic inflammatory disease occurs when bacteria move from the vagina or cervix Andenomyosis into the uterus, ovaries or fallopian tubes. Long-term problems, including infertility, ectopic pregnancy and Endometriosis is a chronic pelvic pain, can occur if the infection is not disorder in which treated promptly. tissue that normally lines the inside of Symptoms of pelvic inflammatory disease include the uterus grows abnormal vaginal discharge, pain in the abdomen, outside of the uterus. abnormal menstrual bleeding, painful urination, Symptoms include pain during intercourse, fever and chills, and nausea painful periods; painful and vomiting. However, some women with pelvic intercourse, urination inflammatory disease have only mild symptoms or no or bowel movements; and symptoms at all. excessive bleeding. Fertility Pelvic inflammatory disease is treated with antibiotics. problems can also develop. Women who are pregnant or with severe symptoms Because endometriosis can be a challenging condition may need to be treated in a hospital. In addition, the to manage, an early diagnosis and multidisciplinary patient’s sexual partner(s) need to receive antibiotic medical team may result in more effective treatment treatment. of your symptoms. To check for the presence of endometriosis, your doctor will conduct a pelvic Ovarian Cysts exam. Follow-up diagnosis may include an ultrasound exam, laparoscopic procedure and biopsy. An ovarian cyst is a fluid-filled sac that forms on one of a woman’s two ovaries. They often develop The first line of treatment for endometriosis is during ovulation, when the ovary releases an egg often hormonal medications. Your doctor may each month. Ovarian cysts are usually harmless with also recommend medications to manage pain. no symptoms. However, sometimes an ovarian cyst If the pain persists, surgery may be required. can cause abdominal pain, swelling, painful bowel Laparoscopic surgery involves small incisions in the movements and pain during intercourse. abdominal wall, allowing the surgeon to remove the endometriosis using radiofrequency, microwave The most common causes of ovarian cysts include energy, electrosurgery or carbon dioxide laser. endometriosis, pregnancy, severe pelvic infections, For severe cases, more extensive surgery called hormonal problems or medications used to help you laparotomy may be required. ovulate. Detection of an ovarian cyst starts with a pelvic exam. Further tests may include an ultrasound Andenomyosis is a related condition in which exam, pregnancy test, hormone testing or blood test to endometrial tissue grows inside the uterus into the determine if you may have ovarian cancer. uterus wall. Symptoms include heavy or prolonged menstrual bleeding, severe cramping during If the cyst doesn’t go away on its own or if it grows menstruation, an enlarged uterus, pain during larger, your doctor may recommend one of the intercourse and blood clots that pass during menstrual following treatments: bleeding. Treatments include anti-inflammatory • Birth control pills – to stop ovulation and prevent drugs, hormone medications and, in severe cases, the development of new cysts hysterectomy. • Laparoscopy – to surgically remove a small cyst Pelvic Inflammatory Disease through a small incision in your abdomen • Laparotomy – to surgically remove a large Pelvic inflammatory disease is an infection of cyst through a large incision in your abdomen, the female reproductive organs, often caused by followed by a biopsy to determine if the cyst is gonorrhea and chlamydia, which are sexually cancerous Choose to Be Informed About ChronicPreparing Pelvic Painfor SurgeryConditions | | 3 4 Uterine Fibroids Urinary Tract and Fibroids are noncancerous growths that form in Vaginal Infections and around the wall of the uterus, often appearing A urinary tract infection (UTI) is an infection in any during childbearing years. While fibroids are typically part of the urinary system, including the bladder, noncancerous, they can cause pain, vaginal bleeding, urethra or kidney. Symptoms of a UTI include a heavy periods, pelvic pressure, painful intercourse, burning feeling during urination, a frequent or intense obstructive urinary and bowel symptoms, and urge to urinate, pain or pressure in the back or lower reproductive problems in some women. abdomen, feeling tired or shaky – and, if the infection Your doctor will diagnose your fibroids using has reached your kidneys — fever or chills. an ultrasound, MRI or other imaging technique UTIs are caused by bacteria that most often come and determine the best treatment based on the from the digestive tract or rectal area, and can be fibroid’s size and location. Treatment options may transmitted during intercourse. Antibiotics are the include nonsurgical, minimally invasive or surgical standard medical care for a UTI. If your UTI was procedures to help shrink your fibroids. One such sexually transmitted, your partner(s) will need to be procedure, called a uterine artery embolization, treated too. cuts off the fibroid’s blood supply. This procedure is performed by interventional radiologists as an Vaginal infections, also known as vaginitis, can cause outpatient procedure done under light anesthesia. discharge, irritation and pain during intercourse and urination. These three types of vaginal infections are Other treatment options include: the most common: • Medication – Drug therapy may help alleviate • Vaginal yeast infection, also known as vaginal heavy bleeding and painful periods, but it will not candidiasis, is caused by an infection involving an stop fibroid growth. overgrowth of fungus or yeast. • Myomectomy – A procedure that involves • Bacterial vaginosis is caused by an overgrowth